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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609749
Report Date: 12/03/2024
Date Signed: 12/03/2024 02:21:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/25/2024 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20241125125419
FACILITY NAME:ENCINO GARDENSFACILITY NUMBER:
197609749
ADMINISTRATOR:ARUTUNYAN, ALEXFACILITY TYPE:
740
ADDRESS:4930 NOELINE AVETELEPHONE:
(818) 983-5598
CITY:ENCINOSTATE: CAZIP CODE:
91436
CAPACITY:6CENSUS: 2DATE:
12/03/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Rod WycocoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff are not abiding to the admission agreement
Staff are not providing comfortable and healthful accommodations for the residents
Staff did not provide a notice of alterations to the facility
Staff did not prevent the residents from having accessing to harmful items
Staff did not properly notify change of ownership/control of the facility

INVESTIGATION FINDINGS:
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On 12/03/24, at 9:15am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Caregiver, Rod Wycoco. The administrator was called but there was no answer. The administrator's brother arrived about an hour after LPA's arrival-Sevak Arutyunyan. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 12/03/24, LPA Saucedo asked for the census, staff, and resident rosters. On 12/03/24, LPA Saucedo conducted a physical tour and interviewed staff and residents.

LIC 9099C-continued



Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
VISIT DATE: 12/03/2024
NARRATIVE
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Regarding the allegation: Staff are not abiding to the admission agreement. It is being alleged that there has been a rent increase in which the residents did not receive sixty (60) days’ notice and have also been told they need to be out of the facility by 12/1/24 if they are not willing to pay. During LPA's interview with the caregiver, the caregiver admitted that there was four (4) residents living at the facility but two (2) were moved out 12/01/24 and does not know where they were moved to. LPA interviewed two (2) residents that confirmed they will also be moving out soon. One (1) resident confirmed they will be moving out today-12/03/24. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) above is SUBSTANTIATED at this time.

Regarding the allegation: Staff are not providing comfortable and healthful accommodations for the residents. It is being alleged that because construction is being conducted at the facility residents have experienced paint fumes, hammering and excessive noise. During LPA's physical tour, LPA observed construction in the hallway in between the rooms with excessive noise. One (1) staff did confirm that there is construction being conducted. Two (2) residents confirmed that there is excessive noise. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) above is SUBSTANTIATED at this time.

Regarding the allegation: Staff did not provide a notice of alterations to the facility. It is being alleged that there is construction being done inside the facility. During LPA's physical tour, LPA observed construction in the hallway in between the rooms. LPA took pictures of the construction being conducted. LPA also confirmed that Community Care Licensing department was not notified of the altercations to the facility being conducted. One (1) staff did confirm that there is construction being conducted. Two (2) residents confirmed that there has been construction to the above facility since the facility has been bought and has new owners. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) above is SUBSTANTIATED at this time.

LIC9099C-continued

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
VISIT DATE: 12/03/2024
NARRATIVE
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Regarding the allegation: Staff did not prevent the residents from having access to harmful items. It is being alleged the residents have access to knives and tools while there is construction being conducted. During LPA's physical tour, LPA observed construction in the hallway in between the rooms with tools exposed to the residents. LPA took a picture of the tools being exposed. One (1) staff did confirm that there is construction being conducted. Two (2) residents confirmed that since new management bought the house there has been construction being conducted. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) above is SUBSTANTIATED at this time.

Regarding the allegation: Staff did not properly notify change of ownership/control of the facility. It is being alleged that there is new ownership/administration/control of the facility. Two (2) residents were interviewed and confirmed that the above facility has been sold and there is also a new administrator. One (1) staff confirmed that they are new to the above facility and is taking care of two (2) residents and is unaware of what was being done and the future intentions of the above ownership/control of the facility. Therefore, based on the LPA's observations, staff, and resident interviews the above allegation(s) above is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued and a civil penalty for the above allegation(s), appeal rights were given and a copy of this report was given to the Administrator's brother.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
87507(4)B)
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(4) Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change..(B) The conditions under which a licensee may increase or change rates shall be specified in the admission agreement..This requirement is not met by:
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Administration/Licensee will need to abide by their admission agreement page 71 and send notification to LPA of where the residents were transferred to.

POC Due Date: 12/17/24
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Based on the observation and record review of the facilities' admission agreement page 71, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.
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Type B
12/17/2024
Section Cited
CCR
87202(a)
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(a) All facilities shall maintain a fire clearance...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by:
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Administration/Licensee will need to contact the fire department to receive immediate fire clearance and send notification to LPA.

POC Due Date: 12/17/24
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Based on the observation and record review, the licensee did not comply with the section cited above in several (areas) of the facility which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
87208(a)
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(a) Each facility shall have and maintain a current, written definitive plan of operation...Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:This requirement is not met as evidenced by:
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The licensee/administrator will submit a written declaration explaining the steps that they are going to take to complete the project and notify the LPA.

POC Due Date:12/17/24
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Based on the observation, interview and record review, the licensee did not comply with the section cited above in submitting a written declaration stating that there will be structural changes to the facility which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
12/17/2024
Section Cited
CCR
87305(a)
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Prior to construction or alterations, all facilities shall obtain a building permit.

This requirement is not met as evidenced by:
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The licensee/administrator will submit a copy of the payment and new facility sketch submitted to the building permit department and notify LPA

POC Due Date:12/17/24

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Based on the observation, interview and record review, the licensee did not comply with the section cited above in structural changes which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2024
Section Cited
CCR
87303(a)
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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:
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The Administration/Licensee will need to keep all areas of construction clean, safe and sanitary at all times for residents and notify LPA when repairs will need to be completed.

POC Due Date: 12/17/24
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Based on the observations, the licensee did not comply with the section cited above in the areas of construction being clean, safe and sanitary for residents which poses/posed a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 31-AS-20241125125419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ENCINO GARDENS
FACILITY NUMBER: 197609749
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2024
Section Cited
CCR
87355(e)(1)
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Criminal Clearance 87355(e)(1) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by:
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LPA requested adminstrator to remove the individual from the facility area as soon as possible. Within 24 hours licensee must inform RO that the individual is removed and will not return to facility without criminal record clearance and association. A $300.00 civil penalty will be assessed at the time of this visit.
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Licensee failed to obtain criminal clearance/background association for an indvidual that is currently working as a staff which poses an Immediate Health, Safety or Personal Rights risks to persons in care.
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Type B
12/17/2024
Section Cited
CCR
87407(k)(1)
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(k) Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office responsible for receiving information regarding personnel changes at the licensed facility..This requirement is not met as evidenced by:
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The licensee/administrator will notify Community Care Licensing Deparment of administration/ownership changes and qualifications of changes to the above facility.

POC Due Date:12/17/24
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Licensee/Administrator failed to notify Community Care Licensing Department of any changes of ownership/administration changes which poses an Immediate Health, Safety or Personal Rights risks to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024
LIC9099 (FAS) - (06/04)
Page: 7 of 7